Rubinstein-Taybi syndrome is a multiple anomalies congenital disorder characterised by broad thumb and halluces, facial dysmorphism with mental and growth retardation. Oral features include small mouth, retro and micronagthic jaws, highly arched and narrow palate. Dental anomalies such as teeth with talon cusps and screwdriver shaped permanent incisors together with crowded teeth are common features in these patients. Although hyperdontia is said to be one of the features of this condition, nevertheless, presence of multiple supernumerary teeth has never been documented. This report highlighted a case of an eleven-year-old boy with Rubinstein-Taybi syndrome referred for unerupted permanent incisors who exhibited multiple supernumerary teeth radiographically.
The use of fluoride as a preventive measure for dental caries has been established more than 50 years ago. The recommendations for fluoride use has been modified over the years due to factors like decreased prevalence of caries, increased prevalence of dental fluorosis and the widespread availability of fluoride in various forms to the community. In recent years, the role of evidence-based recommendations has come to the forefront, in an attempt to ensure the most favorable treatment for the individual. This review has attempted to appraise the most recent evidence- based recommendations for different fluoride modalities put forth by various organizations worldwide, in order to appreciate the current status of fluoride in the early 21st century.
This paper describes the use of stereophotogrammetry approach to measure and hence identify accurately threedimensional (3D) coordinates of important landmarks on a craniofacial surface. A "novel" technique dubbed as "natural features" technique was employed to accurately compute the 3D coordinates of selected craniofacial landmarks. The natural features technique involves the use of 3D coordinates of the natural features (such as acne, scar, corners of eyes, edge of mouth, point of chin, etc.) that appear on the craniofacial surface as an absolute stereophotogrammetric mapping control points. The 3D coordinates of the natural features were gained using digital photogrammetric bundle adjustment method. Validation of the proposed technique has firstly been carried out using mannequin and finally, it was applied on the real-life human faces. The result shows that the craniofacial landmark measurement accuracy of 0.8mm with one standard deviation can be successfully achieved by the proposed technique.
Abstract Water quality in the dental unit waterlines (DUWLs) is important to the patients and dental health care personnel as they are at risk of being infected with opportunistic pathogens such as Pseudomonas or Legionella species. In this study, a total of 86 samples were collected from DUWLs of 19 dental units in 11 Malaysian Armed Forces dental centres (MAFDC). 350 ml water sample was collected in sterile thiosulphite bags from the outlets of 3–way syringe, high speed handpiece, scaler, cup filler, independent water reservoir or the tap of the same surgery respectively. Samples were transported to the laboratory within 24 hours and kept in the refrigerator at 40C. 100ml of each sample was filtered through a 0.45 μm polycarbonate membrane filter. The filter was then inoculated onto plate count agar and incubated at 370 C for 24 hours, after which the formed colonies were enumerated. Another separate 100ml of water sample was poured onto buffered charcoal yeast extract agar and cetrimide agar to culture Legionnella and Pseudomonas respectively. Identification of these bacteria were confirmed by polymerase chain reaction and sequencing. Pseudomonas aeruginosa was detected in 9.5% of the samples but Legionnella was not detected in any of the samples. 77% of the samples met American Dental Association (ADA) recommendation of less than 200 cfu/ml. The result of this study showed that it is difficult if not impossible to eliminate biofilm from the DUWLs. Regular monitor of water quality from DUWL is required to maximise the health of the dental patients and dental health care personnel.
Prevalence of dysphagia is one of the important epidemiological data which will contribute to the proper planning and support the setting up of a swallowing rehabilitation clinic at this hospital. The present study aimed to determine the prevalence of dysphagia in patients with head and neck cancer (HNC) at Hospital Universiti Sains Malaysia (Hospital USM) from 2001-2010. In this institutional retrospective study, a total of 66 records were obtained comprising of 86.4% Malay patients, 9.1% Chinese, 1.5% Indians, and 3% other ethnic groups. These data were taken from the database of HNC patients seen at the dental clinic, Hospital USM between 2001 and 2010. Difficulty swallowing, frequent coughing during meal, choking, diet modification, and non-oral nutritional support were identified as signs and symptoms associated with dysphagia. Results showed that 59.1% of patients have had dysphagia before, during, or after the treatment of HNC. Data from the present study would be instrumental in increasing awareness among clinicians involved in patient care and it may help in planning the outline of management of dysphagia. Furthermore, it is anticipated to have implications for further research in swallowing and dysphagia.
Study site: Dental clinics, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
The purpose of this study was to evaluate hardness (indicator for polymerization) and thickness of two types of resin cement at coronal, middle and apical level of tooth root canal. Ten extracted maxillary incisors were instrumented and post space was prepared for cementation of titanium post. Samples were divided into two groups and each group was cemented either of the two types of resin cements; Panavia F [dual-cured (PF)] and Rely X Luting 2 [self-cured (RL)]. The teeth were longitudinally sectioned; hardness and thickness was measured using Vickers hardness tester and a microscope (Leica DMLM). SEM observations along the cement line at the 3 different root levels were performed. Statistical analysis was performed to test significance of differences in hardness and thickness of the two types of cement (t-test; p= 0.05) and at different levels of the same type (one-way ANOVA followed by multiple comparison; p= 0.05). Significant difference of hardness was found at the apical level between the two groups and between the coronal and apical level of PF (p0.05). Moreover, voids were more obvious within the dual-cured group of cement. Dual-cured resin cement was found to be less polymerized than self-cured type at apical level. Increased thicknesses of resin cements in comparison to post space size were observed in both groups. Use of metallic post with resin cements needs further evaluation.
Surgical ciliated cyst of the maxilla is a rare complication following surgical procedures or trauma
involving the maxillary sinus. It can occur at any time after any procedures or trauma involving the maxillary
sinus even though many years have lapsed. Clinically it may mimic other cysts of the maxillary sinus
therefore a thorough history taking is necessary for diagnosis. Treatment is usually by enucleation or
marsupialisation. This report highlighted a case of surgical ciliated cyst involving the right maxillary sinus
probably secondary to maxillary sinus procedures, which were performed 30 years prior to presentation.
Xeroderma pigmentosum-D (XPD) is one of the genes that play a role in the Nucleotide-Excision Repair (NER). Polymorphisms in XPD gene have been identified and reported to be associated with many types of cancer with two common single nucleotide polymorphisms (SNPs), namely, XPD312 and XPD751. The XPD312 polymorphism is at exon 10 codon 312 Asp to Asn (A→G) and the association of this polymorphism with oral cancer is very little known, especially, in Malaysia. The aim of this study was to screen for XPD312 gene polymorphisms in human oral cancer patients attending Hospital Universiti Sains Malaysia (HUSM), Malaysia. Blood samples were collected from 10 oral cancer and 10 normal healthy subjects with their consent. DNA was extracted using commercial DNA extraction kit and Polymerase Chain Reaction (PCR) was performed to amplify the XPD312 gene. The PCR products were digested using restriction enzyme, Sty I and analyzed on a 3% agarose gel for the detection of polymorphisms. This was followed by DNA sequencing to confirm the findings. In the current study, only homozygous wild type polymorphisms in the XPD312 gene was noticed in the oral cancer tissues as revealed by the restriction enzyme and DNA sequencing analyses.
Clinacanthus nutans (C. nutans), a well-known ethnopharmacological plant consumed for its medicinal purposes by Southeast Asian communities. C. nutans is said to possess antipyretic, inflammatory, antiedemic as well as analgesic properties and used traditionally in treating various skin ailments, Herpes infection, cancer and diabetes. The young leaves of this C. nutans are consumed in Malaysia for maintaining health. In this study, the proliferative activity of human gingival fibroblast cells (HGF-1, ATCC®CRL-2014™, USA) treated with the ethanol extract obtained from C. nutans leaves at three different concentrations (250, 125 and 62.5 µg/ml) was compared with the untreated cells using alamarBlue assay. The proliferative activity of HGF-1 using alamarBlue assay showed that the cells treated with 62.5 μg/ml of ethanolic extract of C. nutans leaves exhibited increased proliferation compared to the other groups and hence does not exhibit any cytotoxicity on HGF-1.
Surgical removal of impacted lower wisdom tooth has become increasingly costly to patient while still remains as the most common dental surgical procedure that is performed on outpatient basis. In the present study, a total of 23 patients with impacted lower wisdom tooth were surgically removed under local anaesthesia by using different irrigating solution namely, normal saline, distilled water and chlorhexidine. The samples underwent standard operating procedures and medication. Post operative complications in terms of pain, swelling, infection and delayed wound healing were assessed and compared on Day 1 and Day 7 after surgery. The result of this study showed that there is no significant difference between the three irrigating solution used in surgical removal of impacted lower wisdom tooth in terms of postoperative complication. A bigger scale of research with more samples is recommended to evaluate the most efficacy irrigating solution during surgical removal of impacted lower wisdom tooth.
Study site: Oral surgery clinic, Universiti Sains Islam Malaysia (USIM), Kuala Lumpur, Malaysia
This study aimed to assess the nutritional status (BMI), oral health behaviour, sugar consumption and the associated factors with dental caries among a group of 7 to 11 years old children in Kuala Lumpur, Malaysia. Three hundred and twelve students were recruited from February to July 2013. Information gathered were their socio-demographic characteristics, body mass index, sugar consumption, oral-health behaviour, oral hygiene index and decay-missing-filled teeth (dmft) index. Anthropometry measurements and sugar intake was measured using verified tools. Meanwhile, dmft was examined using the World Health Organization (WHO) criteria. 53.7% of the children were of the normal body weight with mean sugar consumption of 31.81±4.24 g/day. Prevalence of dental caries was reported at 44.6% (95% CI: 42.2, 53.3) with a mean (SD) dmft of 1.27(1.84). No association was found between dental caries and weight status distribution. Most children tend to brush their teeth 2 times or more in a day (75%), however, they spent lesser time in tooth brushing (5.4%) and do not practice flossing (78%). Regression analysis showed that age (p
Some of the beneficial bio compatible properties of hydroxyapatite [Ca10(PO4)6(OH)2]; the major componentand an essential ingredient of normal bone and teeth, are that it is rapidly integrated into the human body and will bondto bone forming in distinguishable unions. But, before new materials are approved for medical use, mutagenesis systems to exclude cytotoxic, mutagenic or carcinogenic properties are applied worldwide. This study aimed to detectany chromosomal aberrations induced by the synthetic hydroxyapatite granules [Manufactured by Universiti Sains
Malaysia, (USM) Penang, Malaysia] in the bone marrow cells of mice. The mitotic indices of the groups treated with synthetic hydroxya patite granules did not show any significant difference as compared to the negative control group treated with distilled water. Also the groups of mice treated with synthetic hydroxyapatite granules and distilled waterdid not induce significant change in chromosome aberrations as compared to the positive control group treated with Mitomycin C. The mitotic indices and chromosomal analyses indicate that under the present test conditions, synthetichydroxya patite granules (manufactured by USM) are non cytotoxic and do not induce chromosome aberrations in the bone marrow cells of mice.
Dentistry has searched for an ideal material to place in osseous defects for many years. Endogenous bone replacement has been the golden standard but involves additional surgery and may be available in limited quantities. Also, the exogenous bone replacement poses a risk of viral or bacterial transmission and the human body may even reject them. Therefore, before new biomaterials are approved for medical use, mutagenesis systems to exclude cytotoxic, mutagenic or carcinogenic properties are applied worldwide. The present preliminary study was carried out in five male New Zealand white rabbits (Oryctolagus cuniculus). Porous form of synthetic hydroxyapatite granules (500 mg), manufactured by School of Materials and Mineral Resources Engineering, Universiti Sains Malaysia, Penang, was implanted in the femur of the rabbits. Blood samples were collected prior to implantation and one week after implantation. The blood was cultured in vitro and the cell division was arrested at metaphase using colcemid. This was followed by the hypotonic treatment and fixation. Then, the chromosomes were prepared and stained for analysis. The modal chromosome number of rabbit (Oryctolagus cuniculus) was found to be 2n=44. The mean mitotic index values prior to and after implantation were 3.30 ± 0.66 and 3.24 ± 0.27 per cent respectively. No gross chromosome aberrations, both numerical and structural were noticed either prior to or after implantation of the biomaterial. These findings indicate that the test substance, synthetic hydroxyapatite granules does not produce gross chromosome aberrations under the present test conditions in rabbits.
Osteomyelitis of the mandible, a serious complication of untreated odontogenic infection has been reported. This case report describes an interesting presentation of chronic suppurative osteomyelitis (CSO) of the mandible in a 13 years old anaemic male patient. Investigations revealed inversion of his permanent teeth leading to trans-cutaneous extra-oral eruption along with marked destruction of mandible on the affected side. The treatment included a pre surgical course of antibiotics followed by the removal of the retained second premolar tooth, surgical debridement of the affected bone, and resection of the cutaneous sinus tract. The post-operative healing was uneventful. A combination of antibiotic therapy and surgical debridement were effective in the treatment of chronic suppurative osteomyelitis.
This is a retrospective study to determine the distribution site, associated fracture and causes of mandibular fractures at HUSM, over a 5 year period, from 1st January 2002 - 31st December 2006. Records of patients who had mandibular fracture were reviewed. Data of age, sex, site of fracture, causes and associated fracture were recorded and analyzed using SPSS version 15.0. There were 113 (84.3%) males and 21 (15.7%) females. The mean age for male was 84.3% and female was 15.7%. The fracture occurs mostly at the age of 11-20 years (45.5%), followed by 21-30 years (30.6%). Motor vehicle accidents (MVA) were the commonest causes of mandibular fracture (92.5%), followed by fight and assault (3.7%), industrial accidents (3.0%), fall (0.7%). There were no cases recorded due to sport injury. The commonest site of mandibular fracture occurs at angle and para-symphysis (23%), followed by body (20.1%), symphysis (16.7%), condyle (15.5%) and ramus (1.7%). The most common associated fractures were head injury (23.5%), followed by clavicle fracture (17.2%) and fracture of radius (10.7%). Mandibular fracture was common in males with the mean age 24.63 years and mostly due to MVA. Angle and para-symphysis is the commonest site of mandibular fracture with most of the patient suffered from concomitant head injury.
Ameloblastoma is a slow growing benign tumour of the jaw and patients usually present late after the tumour achieved considerable size to cause facial disfigurement. Diagnosis mainly from tissue biopsy and characteristic findings on plain X-rays does assist in differentiating between types of ameloblastoma. The challenges in the management of this tumour are to provide complete excision as recurrence may occur in incomplete removal and also to reconstruct the bony defect in order to give reasonable cosmetic and functional outcome to the patient.
Paediatric facial traumas are often accompanied by other intracranial and non-head injuries. Use of
Computed Tomography (CT) has increased diagnostic accuracy when compared to plain radiographs alone. Coexisting anomalies can sometimes be a chance finding from the imagings and this highlights the need of a formalreporting by a radiologist. We report a case of a traumatic unilateral condylar fracture with a coexisting life-threatening abnormality detected from careful assessment of the imagings.
Root canal treatment (RCT) requires high level of technical skills of the dentist. Its outcome is an important part of evidence-based practice and become the basis of treatment planning and prognostic considerations. Adequate removal of micro-organisms and prevention of recolonization of residual micro-organisms through the placement of root filling with satisfactory coronal seal ensures success. This retrospective record review study aimed to investigate the practices of RCT in Hospital Universiti Sains Malaysia (HUSM) Dental Clinic, Kota Bharu, Kelantan. It involved 333 randomly selected patient records at the HUSM Record Unit. Data was obtained by careful analyses of daily treatment progress sheets and analyzed using SPSS version 12.0. A total of 2996 RCT cases were seen and 59.8% of patients were females. The age range of patients varied from 14 to 64 years. The maxillary anterior teeth were most commonly treated (52.6%). Most operators (99.1%) used step-back technique and 97.6% used files to prepare root canals. The most commonly used material for obturation and sealing was gutta-percha and epoxy resin-based sealer (AH26). About 82.9% used calcium hydroxide as intra-canal medication. About 25.5% of cases had no periapical pathology, 65.8% with pre-existing periapical radiolucencies healed in 1-3 months whereas 2.1% of cases with periapical pathology eventually healed after a year. About 6.9% cases failed after retreatment. The number of radiographs taken was two to four pieces. RCT is a useful intervention to maintain longevity of teeth. Decision making and current updates of methods and materials are essential among practitioners as well as administrators to ensure success.
Pyogenic granuloma is a benign lesion which is commonly found in the oral cavity. It is a reactive inflammatory process of the injured mucosa to trauma. It can appear as a sessile or pedunculated mass with smooth or lobulated surface, which sometimes can mimic malignant lesion. Excision biopsy of the lesion is the confirmatory investigation which also a treatment tool. We report a case of middle-aged lady who had pyogenic granuloma of the tongue, which was safely excised using ultrasonic scissors. This case highlights the new technique of using ultrasonic instruments for excision of benign tongue lesion, with marked reduction of blood loss and operation time.
Lingual tonsil is a part of Waldeyer’s ring. It consists of lymphoid follicles and subject to proliferation and hypertrophy. Palatine tonsillitis, by far is the commonest cause of odynophagia originating from oropharyngeal region. Lingual tonsillitis is a rare occurrence. We reported a patient who presented with severe odynophagia after two months of palatine tonsillectomy. Examination revealed the lingual tonsils were inflamed and covered with exudates.